SSD is defined so over inclusively by DSM 5 that it will mislabel 1 in 6 people with cancer and heart disease; 1 in 4 with irritable bowel and fibromyalgia; and 1 in 14 who are not even medically ill.

I hoped to be able to influence the DSM 5 work group to correct this in two ways: 1) by suggesting improvements in the wording of the SSD criteria set that would reduce mislabeling; and 2) by letting them know how much opposition they would face from concerned professionals and an outraged public if DSM 5 failed to slam on the brakes while there was still time.

And many of you tried to help by making clear just how important this issue is in people's lives. The blog post got many tens of thousands of views, was reposted on 70 additional sites; was widely Tweeted and Facebooked, and elicited more than 300 extremely well informed and often passionate comments- unanimously in strong opposition.

We have failed and DSM 5 has failed us. For reasons that I can't begin to fathom, DSM 5 has decided to proceed on its mindless and irresponsible course. The sad result will be the mislabeling of potentially millions of people with a fake mental disorder that is unsupported by science and flies in the face of common sense.

I suggested simple wording changes in the DSM 5 definition of SSD that would have tightened it significantly and reduced confusion at the difficult boundary between medical and mental illness. Naively, I thought my suggestions were so obviously necessary that DSM 5 would find them easy to accept and impossible to refuse.

The new criteria set would have made it much clearer that the person's concern about physical symptoms had to be 'excessive', 'maladaptive', 'pervasive', 'persistent', 'intrusive', 'extremely anxiety provoking', 'disproportionate', and 'consuming enough time to cause significant disruption and impairment in daily life'.

And I also suggested adding these new items to the criteria set to reduce the most common sources of inappropriate over diagnosis of Somatic Symptom Disorder.

• 'If a diagnosed medical condition is present, the thoughts, feelings, and behaviors must be grossly in excess of what would be expected given the nature of the medical condition.'

• 'If no medical diagnosis has yet been made, a thorough medical work-up should be performed and be repeated again at suitable intervals to uncover possible medical conditions that may declare themselves with the passage of time.'

• 'The concern about physical symptoms should not be not better accounted for by another mental disorder (eg Anxiety, Depressive, or Psychotic Disorder).'

Many of you would argue that I didn't go nearly far enough- that there should be no 'Somatic Symptom Disorder' at all in DSM 5 because there is no substantial body of evidence to support either its reliability or its validity. People who are concerned about medical problems would either not be diagnosed with any mental disorder or when necessary would get a much more benign and nonspecific diagnosis of 'Adjustment Disorder.'

I am sympathetic to this view, but realized that it would have no traction with the work group and chose instead to lobby for what seemed to be clearly essential and relatively easy changes that would solve most, if not all, of the problem.

My goal was to make it almost impossible for DSM 5 to say no to what are obviously needed improvements. My suggestions were no more than standard stuff- just the typical exclusionary wording that has always been used in DSM criteria sets to encourage careful differential diagnosis and to reduce inaccurate over diagnosis. Making the changes so easy was intended to be the carrot.

And I also brandished a stick. My letter cautioned DSM 5 that it was invading dangerous territory. Here was my warning to the DSM 5 work group:

• 'Clearly you have paid close attention only to the need to reduce false negatives, but have not protected sufficiently against the serious problem of creating false positives. You are not alone in this blind spot—in my experience, inattention to false positive risk is an endemic problem for all experts in any field. But your prior oversight needs urgent correction before you go to press with a criteria set that is so unbalanced that it will cause grave harms.'

• 'When psychiatric problems are misdiagnosed in the medically ill, the patients are stigmatized as 'crocks' and the possible underlying medical causes of their problems are much more likely to be missed.'

• 'Continuing with your current loose wording will be bad for the patients who are mislabeled and will also be extremely harmful to DSM 5, to APA, and to your own professional reputations.'

I also raised the point that this could lead to a boycott of DSM 5. Pretty strong stuff, I thought. But totally ineffective. DSM 5 remained blind to dangers, deaf to entreaties. Its startling failure to correct this obvious and harmful mistake is breathtakingly wrongheaded and exceeds even my most pessimistic expectations about DSM 5's lack of competence and credibility.

Suzy Chapman is not surprised. For three years, she has been engaged in a determined effort to educate professionals and the public about the problems in DSM 5 and has been doing her best to help correct them. Her website provides the most complete documentation of everything related to DSM 5 and ICD 11. (http://dxrevisionwatch.com/ )

Ms Chapman writes: "Unfortunately, the DSM 5 invitation for comments from the field turned out to be no more than an empty public relations show. For the second stakeholder review of DSM 5 draft criteria, the SSD disorder section attracted more submissions than almost any other section. Yet still the Work Group barreled blindly on with suggestions that were roundly opposed as hurtful to the medically ill — shrugging off criticism from professionals and remaining completely unreceptive to advocacy organization and patient concern.

"For its third draft, rather than revise in favor of less inclusive criteria, the Work Group's response was to lower the threshold even further — reducing the requirement for 'at least two from the B type criteria' to just one — placing even more medical patients at risk of attracting an inappropriate mental health diagnosis."

"Many years ago, the late Thomas Szasz said: 'In the days of the Malleus, if the physician could find no evidence of natural illness, he was expected to find evidence of witchcraft: today, if he cannot diagnose organic illness, he is expected to diagnose mental illness.' DSM 5's loosely defined Somatic Symptom Disorder is Szasz worst fear come true."

Thank you Ms Chapman. I think Szasz' general critique of psychiatry was far too broad, but he certainly did hit the nail right on the head when it comes to DSM 5 and its cavalier treatment of the medically ill. The DSM 5 debacle is a sad moment in the history of psychiatry. Patients deserve better and so does the profession of psychiatry.

I would greatly appreciate your publishing the names and professional affiliations of all members of the DSM-5 Working Group who contributed to the delusional fantasy which is so-called "Somatic Symptom Disorder". I believe it is time that patients started writing to the hospitals and Universities where these idiots have admission privileges. I will personally recommend that every one of these incompetent fools be barred from medical practice on grounds of gross medical malpractice.

Failing that expedient, I very much hope that we can promote an exodus of professionals out of the APA, on grounds that the organization has committed a tangible and totally unnecessary harm to the welfare of medical patients world-wide. I am distributing a copy of this commentary to a wide circle of colleagues, urging them to join in pressuring their own professional organizations to publicly disclaim any acceptance of this fictional disorder as a basis for medical practice standards.

Sincerely,

Richard A. Lawhern, Ph.D.
Moderator and Resident Research Analyst
Living With TN: http://www.livingwithtn.org

I can see now why this was pushed through despite all of the sound criticism. The fact that Michael Sharpe's name is on this list should tell us that the UK psych lobby has struck again. Sharpe is a colleague of Simon Wessely, Peter White, Trudy Chalder, Mansel Aylward, and a number of other psychiatrists with close ties to the disability insurance industry, who have forwarded the spurious claim Myalgic Encephalomyelitis/Chronic Fatigue Syndrome is based on aberrant illness beliefs rather than on a physical cause as demonstrated in thousands of peer reviewed medical journals. The positioning of this diagnosis in the DSM is a calculated, strategic move designed to allow certain mental health professionals to continue to promulgate their unproven theories regarding ME/CFS and other illnesses and to counter the growing body of literature demonstrating the physical bases for these and other contested illnesses.

It's very important to keep in mind that billions of dollars (or pounds, etc.) are at stake. The conservative estimates are that at least one million ME/CFS patients exist in the United States alone and if those million patients had $1000 worth of medical testing done in one year, that amounts to over $1 billion! This is not a trivial amount and certain people within the medical and disability insurance fields know it. The fact that this new diagnostic category in the DSM passed despite the opposition and criticisms by many mental health professionals and well respected clinicians should tell us something; this isn't about diagnostic clarity or the advancement of science, it's about politics and money.

Thank you so much for this brilliant post and your efforts to remove or modify the new SSD classification! You and Ms. Chapman are entirely correct, in my considered opinion. Thank you for being proactive and drafting necessary changes to the SSD. I would be very pleased if they were adopted. Perhaps there is some reason why the more specific (as drafted with your modifications) SSD is preferable to the current diagnosis of adjustment disorder. I, as a layperson, would leave that to the discretion of the working group. But, as you note, the current and final draft of SSD is grossly inappropriate and is certain to cause significant iatrogenic morbidity, both somatic and psychological.

BOYCOTT DSM-5!

As many respected commentators have urged, a boycott of DSM-5 is now the most prudent course of action until SSD is eliminated or redrafted to incorporate your suggested revisions.

Let me add that I have very reluctantly come to the conclusion that a boycott of DSM-5 is necessary. I strongly believe that we need a guiding diagnostic guide in psychiatry such as DSM. On balance, despite its flaws, I am definitely a supporter of DSM IV. I strongly urge professionals to continue to use DSM IV after DSM-5 is published, until SSD is eliminated or revised along the lines of Prof. Frances' suggestions.

I respect many of the opinions of those opposed to psychiatry and recognize that many of them have significant merit. However, I am a supporter of the discipline of psychiatry. I was a psychology major and would have trained to be a psychiatrist if I did not lack giftedness at the hard sciences, which forced me to train to become a lawyer.

In fact, I believe that psychiatry and psychology are the most important disciplines and careers, bar none. Unfortunately though, as in any profession there are bad apples and bad ideas and in the case of SSD we have an archetypical example:

Insurance lobbyists, trained as psychiatrists and posing as scientists have steamrolled through an unscientific and extremely harmful diagnosis.

We can not stand idly by while this travesty occurs. Please join me in the boycott of DSM-5!

For Justin Reilly: Like economics, psychiatry does not deserve the implication of precision or objective validity which attaches to the term "science". "The miserable art" is a closer approximation to truth. And the level of dysfunction and suicidal depression among psychiatrists is second only to that of dentists, among the medical fields. Be glad that you found a profession in which you merely chase ambulances, rather than contribute to putting people in them.

Come on, Justin! This fiasco should be sufficient to convince you or ANYBODY that the criteria for a DSM diagnosis are spurious, unscientific, and downright frivolous. Do you really believe that a group of so-called professionals that could come up with such a stupid and destructive diagnosis as SSD doesn't engage in the same kind of chicanery when defining other "mental disorders?"

Have you read Dr. Frances's other blogs about the DSM 5, stating that it includes, among other things, the expectation that a person who is not substantially recovered from the loss of a loved one in TWO WEEKS is now mentally ill? And that's just one of the fun new diagnostic tricks they have up their sleeves. The goal is clearly to diagnose as many of us as possible, with as little accountability as can be managed, so that they can continue to rip us off for billions of dollars.

Please don't think that the stupidity stops at SSD. Boycott the DSM 5 COMPLETELY - the DSM IV is bad enough. The 5 is downright criminal!

Come on, Justin! This fiasco should be sufficient to convince you or ANYBODY that the criteria for a DSM diagnosis are spurious, unscientific, and downright frivolous. Do you really believe that a group of so-called professionals that could come up with such a stupid and destructive diagnosis as SSD doesn't engage in the same kind of chicanery when defining other "mental disorders?"

Have you read Dr. Frances's other blogs about the DSM 5, stating that it includes, among other things, the expectation that a person who is not substantially recovered from the loss of a loved one in TWO WEEKS is now mentally ill? And that's just one of the fun new diagnostic tricks they have up their sleeves. The goal is clearly to diagnose as many of us as possible, with as little accountability as can be managed, so that they can continue to rip us off for billions of dollars.

Please don't think that the stupidity stops at SSD. Boycott the DSM 5 COMPLETELY - the DSM IV is bad enough. The 5 is downright criminal!

Thank you for your dedication to take the truth of the definitions of Functional Neurological Disorder and Conversion Disorder to this committee. They hold so much power in how we as patients are treated by the medical community. It brings great sorrow to our household that theywere so recalcitrant in not considering your wisdom and experience. Your dedication and commitment brought great hope to many. Thank you again for picking up the banner for those who suffer this dasdardly disease.

And for others who read this thread, could you please inform us in what specialty you trained for your doctorate? My Ph.D. is in engineering systems, though I've spent the last 18 years supporting and advocating for chronic facial pain patients.

Dr Frances and I would like to thank all those who are leaving comments on the first blog in this series and circulating the link.

Comments have been pouring in from patients with diverse chronic illnesses and conditions including Ehlers-Danlos Syndrome, Interstitial Cystitis, Behcet's disease, Endometriosis, Lupus, Hashimotos thyroid disorder, Hughes Syndrome, Pancreatitis and Chronic Lyme disease - many from patients whose symptoms had been dismissed for years before finally receiving a diagnosis or who are still struggling to obtain a diagnosis, some of whom had been mislabelled with a somatoform disorder.

But we need to keep the momentum going and get our concerns in front of as many patient groups as possible.

So please also circulate the link for this follow-up post on blogs, forums and Listservs, newsletters, Twitter, Facebook and other social media platforms and flag up the issue in the comment sections of DSM-5 related media coverage. Inform your friends, family, student and work colleagues, clinicians, allied medical professionals, social workers, political representatives, medical lawyers and advocates.

If you are involved in patient advocacy organizations or with professional bodies, please inform your board members and colleagues.

I suffer Gulf War Illness, caused by vaccines, aggravated by battlefield disorders. Because I was mis-diagnosed with "all in your head" numerous times before any doc would draw my blood, I submitted to VA psychiatrist to rule out so I could pursue physiological causes of my debilitating illness. VA psychiatrist Dr. Frederick Petty, M.D. PhD and his team of psychiatrists at VA Dallas, North Texas, designed written / oral exams for Somatoform Disorder and PTSD. Then Dr. Petty and psychitrists followed up with blood tests that reveal a certain enzyme in patients suffering Somatoform Disorder. All found that Somatoform Disorder is prevalent among patients in their 20s. 30 years and older tested negative. Men, much more often than women, tested positive. Those who served in combat tested positive, while 100% of those who served in non-combat positions tested negative. What most psyches fail to remember is that ALL mental illnesses and psychiatic disorders are valid only when all physiological causes and diseases have been ruled out. That means exhaustive blood tests must be reviewed before any psyche worth his shingle can diagnose any disease "in your head". Gulf War Illness excludes all mental illnesses, depression, brain damage, brain trauma and PTSD. GWI includes Chronic Fatigue as one of approximately 20 different physiological diseases. GWI is 100% fatal 100% of the time, not by suicide or any other mental state. Usually fatal heart attack for all the bio-weapons and vaccine-derived diseases that damage the heart.

Forgot to mention that CDC/NIH requires diagnosing physician to monitor a patient for 6 months before confirming Chronic Fatigue Syndrome. And throughout that 6 months, very specific symptoms such as unrefreshing sleep, swollen lymph nodes, sore throat, various viral symptoms must persist. Somatoform Disorder and depression are supposed to require only 2 weeks. But VA compensation physicians usually diagnose some mental defect within a single 45-minute-or-less general physical exam. VA physicians never review blood or urine tests they order. And VA compensation physicians never contact the Veteran if they find something outrageous or alarming in blood and urine tests. Several psychologists have told me that I can emotionally make myself sick with fever, chills, vomiting, diarrhea, bacterial and viral infections. But those same psyches are unable to come up "medical references" such as clinical studies, peer-reviewed publications or abstracts that prove any person has been able to feign illness to the degree that Chronic Fatigue strikes down its victims.

I recommend a label "Psyche Assumption Disorder" for those who wish to jump to a metal illness diagnosis before genuinely considering and conscientiously testing for physical causes of the symptoms of their patients.
Many a patient has been diagnosed as mentally ill before finally receiving their true diagnosis. A friend of mine was dismissed when he complained of leg pain.* He died *from a clot that traveled from his leg to his lungs because his doctor dismiised it.
I spoke to a woman whose doctor told her she was "worrying for nothing" about the pain and stiffness in her back. Without testing he said that he knew there was nothing wrong with her back. She asked for an "unnecessary back xray" to "put her mind at ease".The xray showed that her spine was fused half way up.

We should be supportive of people's physiological illnesses. We should treat physiological illnesses whenever possible.
We should understand that a range of emotions is normal and variable between people and within the same person.
Emotions as the result of being stricken with illness are valid and should be treated supportively along with the patients' physiological illnesses.

Clearly, as Professor Frances points out, what is somatic ('unrealistic') and what is physical/organic in origin encloses not only how patients cope with their symptoms but also on the quality of the medical evaluation. The latter is dependent on medical skills as well as on prevailing knowledge of the basis of symptoms and syndromes. The assumption of medical investigatory adequacy is not realistic. Are investigations always of sufficient standards to make objective, reliable and provable diagnoses under all circumstances, even when expensive molecular or radiological technologies are needed but not performed?

MUPS is a case in point. The collusion between ineffective medical assessments and over enthusiastic psychologists, psychiatrists, medical insurance and health financing bodies to create a dumping ground for failed medical assessments, and arrogant attitudes, is appalling.

Even in cases not diagnosed as somatic or MUPS, modern expectations of patients of their doctors to perform procedures in such unnecessary numbers to cause huge medical expenses/profits, runs in parallel with the MUPS/somatic phenomenon.

Huge numbers of colonoscopies, to take one example, are performed these days to identify the occasional polyp. Also, before the days of readily available CT head scans left many patients wondering if they had a (a) brain tumour as the cause of their headaches or (2) something more 'benign'. Oh, what a difference a normal CT head scan makes!

So, what to do now for all those patients with normal colonoscopies and CT head scans? MUPS/somatic diseases of course! Huge profits and no responsibilities - the new medical and psychiatrists dream. And all legal too: it's the patient's fault after all now - and the medical and psychiatric professions can sleep comfortably at night, with full pockets, at the expense of this new somatic phenomenon imposed on unknowing patients.

Thanks DSM-5. Give doctors a round of applause. We have worked it all out. No need for new research. Everything is now rosy. Somatic control of the masses (unless you are rich and famous).

I once believed that science moved forward ultimately by consensus. Here, we see that medical dictators are using their influence rather than common sense to operate for self interest, and to pleasure their egos and misguided minds.

Clearly, as Professor Frances points out, what is somatic ('unrealistic') and what is physical/organic in origin encloses not only how patients cope with their symptoms but also on the quality of the medical evaluation. The latter is dependent on medical skills as well as on prevailing knowledge of the basis of symptoms and syndromes. The assumption of medical investigatory adequacy is not realistic. Are investigations always of sufficient standards to make objective, reliable and provable diagnoses under all circumstances, even when expensive molecular or radiological technologies are needed but not performed?

MUPS is a case in point. The collusion between ineffective medical assessments and over enthusiastic psychologists, psychiatrists, medical insurance and health financing bodies to create a dumping ground for failed medical assessments, and arrogant attitudes, is appalling.

Even in cases not diagnosed as somatic or MUPS, modern expectations of patients of their doctors to perform procedures in such unnecessary numbers to cause huge medical expenses/profits, runs in parallel with the MUPS/somatic phenomenon.

Huge numbers of colonoscopies, to take one example, are performed these days to identify the occasional polyp. Also, before the days of readily available CT head scans left many patients wondering if they had a (a) brain tumour as the cause of their headaches or (2) something more 'benign'. Oh, what a difference a normal CT head scan makes!

So, what to do now for all those patients with normal colonoscopies and CT head scans? MUPS/somatic diseases of course! Huge profits and no responsibilities - the new medical and psychiatrists dream. And all legal too: it's the patient's fault after all now - and the medical and psychiatric professions can sleep comfortably at night, with full pockets, at the expense of this new somatic phenomenon imposed on unknowing patients.

Thanks DSM-5. Give doctors a round of applause. We have worked it all out. No need for new research. Everything is now rosy. Somatic control of the masses (unless you are rich and famous).

I once believed that science moved forward ultimately by consensus. Here, we see that medical dictators are using their influence rather than common sense to operate for self interest, and to pleasure their egos and misguided minds.

For DSM-IV, as you know, a specified number of somatic (bodily) symptoms from various body sites were required to meet the criteria for a Dx of "Somatoform Disorder."

A history of many medically unexplained symptoms before the age of thirty, resulting in treatment sought or psychosocial impairment and a total of eight or more medically unexplained symptoms from four, specified symptom groups, with at least four pain and two gastrointestinal symptoms.

(Set out here: http://behavenet.com/somatization-disorder )

And to meet the criteria for DSM-IV's "Undifferentiated somatoform disorder":

A. One or more physical complaints (e.g., fatigue, loss of appetite, gastrointestinal or urinary complaints).

B. Either (1) or (2):

(1) after appropriate investigation, the symptoms cannot be fully explained by a known general medical condition or the direct effects of a substance (e.g., a drug of abuse, a medication)

(2) when there is a related general medical condition, the physical complaints or resulting social or occupational impairment is in excess of what would be expected from the history, physical examination, or laboratory findings

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

But for DSM-5, there is no "hierarchy of aetiology", to use Dr Dimsdale's phrase.

Rather than distinguish between "medically unexplained" somatic (bodily) symptoms and somatic symptoms that might be explained by a known general medical disease or condition, the focus shifts to the patient's cognitive attributions.

That is, the patient's thoughts, feelings, and behaviors and the extent to which the patient is perceived as responding "disproportionately" or "maladaptively" or "excessively" to one or more persistent, distressing bodily symptoms or whether their lives are thought to have become dominated or "subsumed" by their "illness worries" or they are thought to be devoting too much time and energy to their symptoms - irrespective of aetiology. And whether the patient's perception of their level of impairment exceeds what might be expected given the nature of their disease or condition.

So for DSM-5, the new SSD diagnosis can be applied to patients with:

1] A diagnosed medical disease or disorder, eg cancer, heart disease, diabetes, MS;
2] One of the so called "functional somatic syndromes", under which umbrella CFS, IBS, Fibromyalgia, Chronic Lyme disease and a long list of others are often bundled;
3] Somatic symptom(s) for which no underlying aetiology has been established (ie, "medically unexplained");
4] A psychiatric disorder.

Thank you have sharing this very disturbing news. We desperately need to find ways to stop this kind of immoral and inhumane mindset from causing even more damage and suffering. The key question is how best to do so?

"Despite recent evidence that scores on the Psychopathy Checklist-Revised (PCL-R) vary widely in adversarial legal contexts depending on which party retained the evaluator, the test has become increasingly popular in forensic work. In Texas, indeed, Sexually Violent Predator (SVP) evaluators are required by statute to measure psychopathy; almost all use this test. It is not surprising that prosecutors find the PCL-R particularly attractive: Evidence of high psychopathy has a powerfully prejudicial impact on jurors deciding whether a capital case defendant or a convicted sex offender is at high risk for bad conduct in the future.

But a current effort by the instrument's author, Robert Hare, to suppress publication of a critical article in a leading scientific journal may paradoxically reduce the credibility of the construct of psychopathy in forensic contexts."

"Despite recent evidence that scores on the Psychopathy Checklist-Revised (PCL-R) vary widely in adversarial legal contexts depending on which party retained the evaluator, the test has become increasingly popular in forensic work. In Texas, indeed, Sexually Violent Predator (SVP) evaluators are required by statute to measure psychopathy; almost all use this test. It is not surprising that prosecutors find the PCL-R particularly attractive: Evidence of high psychopathy has a powerfully prejudicial impact on jurors deciding whether a capital case defendant or a convicted sex offender is at high risk for bad conduct in the future.

But a current effort by the instrument's author, Robert Hare, to suppress publication of a critical article in a leading scientific journal may paradoxically reduce the credibility of the construct of psychopathy in forensic contexts."

This happened to me - an early note by a PA in my record at a primary care group practice caused the doctors to see my physical condition through a psychological lens.

All I can say is get copies of your records after each visit. Knowing that the note was in there would have saved me a lot of grief. I might not have received a diagnosis any sooner, but at least I wouldn't be wasting my time visiting doctors who weren't going to listen to me.

A heartfelt thanks to all the health professionals who care enough about their patients to stand up against the current position of the APA. Real damage occurs when a patient is told their symptoms are 'just psychological'. Ask anyone diagnosed with 'functional neurological disorder' or 'chronic fatigue syndrome' or any one of these fast-proliferating labels. The patient/doctor relationship is fatally damaged, and for good reason.

I thing this is wrong!!! Flat out wrong. I have Trigeminal Neuralgia, and for us this kind of diagnosis leads to extreme pain!!!!!! AND misdiagnosis!!!! Trigeminal Neualgia is bad enough without people like you trying to make it harder for us to to get treatment for our disease. If you procede with this DSM-5 type theology it makes things very difficult for us, in a world where it is already hard for us. Doctor's already look at us as drug seeking individuals because you cannot SEE our pain.!!!!!
Just because you cannot SEE it does not mean it does not exist.
Maybe you shoud spend more time research a new drug that does not cause more side effects of suicidality for us as we have a hard time living with the reality that we will have debilitating pain for the rest of our lives.
Thank you for your patience and attention to this matter.

FND Hope would like to give a big Thanks to Suzy Chapman and Dr. Allen Frances for the time and dedication they have spent fighting for people that were too ill and for those for whom have no idea they needed to be fighting.

We will continue to fight for Functional Neurological Disorder patients to receive proper medical treatment plans. Humans are suffering across the country and around the world with extreme debilitating conditions. I wonder how much illness anxiety should be expected from those that are in wheelchairs, catheterizing themselves, and falling to seizures walking across the street. This is negligent and inhumane treatment to attach labels and throw these people in to a giant muddy pool of mismatched illness anxiety symptoms. Functional Neurological Disorder/ Conversion Disorder is an illness and should not be reduced to mere over anxious thinking of symptoms.

FND Hope would like to give a big Thanks to Suzy Chapman and Dr. Allen Frances for the time and dedication they have spent fighting for people that were too ill and for those for whom have no idea they needed to be fighting.

We will continue to fight for Functional Neurological Disorder patients to receive proper medical treatment plans. Humans are suffering across the country and around the world with extreme debilitating conditions. I wonder how much illness anxiety should be expected from those that are in wheelchairs, catheterizing themselves, and falling to seizures walking across the street. This is negligent and inhumane treatment to attach labels and throw these people in to a giant muddy pool of mismatched illness anxiety symptoms. Functional Neurological Disorder/ Conversion Disorder is an illness and should not be reduced to mere over anxious thinking of symptoms.

Absolutely disturbing!! Whenever medical professionals do not have an answer for whatever symptoms they don't have a clue about, the answer is always the same, it's in your head. Believe me I have suffered with this for 6 years now, it even ended my 18 year marriage. This I do know!! IT IS NOT IN MY HEAD!

Dr Offord: To ask the Secretary of State for Health what assessment his Department has made of the psychiatric diagnostic manual Diagnosis and Statistical Manual 5. [140608]

Norman Lamb: No such assessment has been made. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders will be published in America in May this year but will not be routinely used in NHS mental health services which use the tenth edition of the International Classification of Diseases, commonly known as the ICD-10. The ICD-10 is developed and produced by the World Health Organization.

Copyright: Lord Hansard

------------------------------------------

Note that although the DSM is not used in the UK to the extent that it is used in the U.S., the DSM-5 will influence the research and literature landscape.

The categories, definitions and criteria within the finalized DSM-5 will also influence proposals for the revision of Chapter 5, the Mental and behavioural disorders chapter of ICD-10, towards ICD-11 (eta currently 2015/16) and influence the harmonization of ICD-11 mental disorder category terms and disorder descriptions with DSM-5.

Thank you Dr. Frances for bringing reason to the DSM 5 debate. I posted the following on my Facebook page with a link to your article, and I hope you and the Psychology Today readership will boycott DSM 5's sale and use. I am a psychiatrist, a neurochemist, and a person who recovered from another so called mental disorder, schizophrenia. I am ashamed of my profession of psychiatry:
"Here is one of many reasons that I believe soon to be released DSM 5 should not be used until corrected. If left as proposed, many people with as yet underlying medical problems such as porphoryria will be labeled with a psychiatric disorder, somatic symptom disorder, which will leave the impression "it is all in their head" and no further medical exploration will be carried out."

This is to announce that the concerns of medical patients for being mislabeled with a mental health issue are being heard. The Ben's Friends organization for rare disorders is sponsoring an online survey of patients who have been referred by a medical doctor to a mental health professional. The survey is initially directed to our 25,000 members in 33 rare disorder support communities -- many of those communities reflected in comments to Dr Frances' blog articles. You do not need to be a member of Ben's Friends to add your voice to those of others whom the DSM-5 places at risk of misdiagnosis with a fictitious disorder and marginalization from further medical care.

Please feel free to visit Survey Monkey, to fill out 30 questions and add your story as a patient:

https://www.surveymonkey.com/s/PF2TFQT

Ben's Friends will collate, analyze and articulate survey results in an article to be offered to online publications like Psychology Today, Digital Journal, and print news media. Our tentative working title for the article is "In Their Own Words -- Patients With Complex Medical Disorders Speak to the American Psychiatric Association."

David J. Kupfer, M.D., chair of the DSM-5 Task Force, has published in defence of the SSD construct, on February 8, at Huffington Post:

http://www.huffingtonpost.com/david-j-kupfer-md/dsm-5_b_2648990.html

"Somatic Symptoms Criteria in DSM-5 Improve Diagnosis, Care"

David J. Kupfer, M.D.
Chair, DSM-5 Task Force

Somatic Symptoms Criteria in DSM-5 Improve Diagnosis, Care
While the goal of the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is clear, accurate criteria for diagnosing mental disorders, the motivation behind the book's revision was the improvement of diagnosis and clinical care. Somatoform disorders are one area where definitive progress was made...

---------

Read Parts One to Three of Dr Allen Frances' series on the SSD criteria:

The APA declined to correct the error, despite multiple warnings.
Published on February 8, 2013 by Christopher Lane, Ph.D. in Side Effects

When DSM-5 is published three months from now, in the middle of May, it will contain at least one major scientific gaffe. The Trustees of the American Psychiatric Association voted to include a definition of Somatic Symptom Disorder (SSD) so broad and over-inclusive that it is certain to include medical patients with an outsized concern about their health, as well as those who are merely vigilant in trying to maintain it...

The fifth edition of psychiatry’s official diagnostic manual, the Diagnostic and Statistical Manual (DSM-5), has gone to print with a new diagnosis included that could easily label millions of normal Americans as mentally ill...

A leaf does not fall from a branch without the silent knowledge of the whole tree. The good, the bad, and the ugly that you allow in your country spreads with alarming rapidity around the world and affects patients that you haven't even thought of yet, so please, please, fight with all your might, before the scourge of your DSM-5 and SSD reaches my country. I am a Trigeminal Neuralgia patient and have already once been refused medical care until after I'd had a psych evaluation. Whilst having my medication withheld, and while suffering what might be the very worst pain known to mankind, I was forced to answer all kinds of personal and intrusive questions which were completely unrelated to my medical condition, and only once that was finished was I given my medicine - a non-narcotic. NOBODY should have to go through that, and nobody who has not suffered this kind of pain should ever have the power to force it on those who suffer the most excruciating pain every day of their lives. Thank you for your efforts!

Dear Dr. Frances,
Thank you for your efforts on behalf of all who suffer from the biological problems of being human and who are aggrieved by those who believe that right attitude. or corrected thinking, trumps nature. The ease of passing off as yet undiagnosable symptoms has been obvious to me from the early '60s. Then in my 20s, healthy, a newly married teacher, happy with my lawyer husband and excited about life ahead, I developed extremely painful GI problems -- sudden diarrhea, which was not related to any virus or bacteria. I was blond, green eyed, and pretty, which also attracted biases. My internist scornfully told me that if I continued like that, (like what?), I would wind up in a mental hospital. For 15 more years with a new doctor, I suffered. I began to notice a pattern: the attacks happened an hour or so after having a carton of whole school milk at lunch and when indulging in ice cream or whipped cream. My new doctor tried to pin the problem on psychological problems with socializing. However, when I was forty, I heard Dr. Dean Edell's radio broadcast from San Francisco about lactose intolerance. I cut out dairy, and viola! No more misery after 15 years and Valium prescriptions (which I did not take, because it didn't help). Identification of this common problem with lack of production of certain digestive enzymes was not known until the late '70s. The DSM 5 dangerously assumes, in a changing world, that all is known about sources of physical illness.

This is very distressing news and I have absolutely no doubt we will discover the insurance industry and/or their lobby is behind this. Only they could advance such a nonsensical diagnostic standard with such obviously harmful results. Now that it has been adopted, I'm basically counting the minutes until I get the letter from my Long Term Disability carrier, notifying me that they will be reclassifying me and invoking the mental health exclusion in my policy. Isn't this the obvious subterfuge behind this?!!

How on earth can a group of people that are supposed to help patients be so dismissive of their illness? I have long thought that money/power are the root of evil but sadly I am more than ever convinced this is so. Even if symptoms do appear to be connected to mental health issues how dare they treat vulnerable people this way? The public must and should question these practices otherwise we may as well be living in the 18/19th century!

This review is from: Authors of our own misfortune?: The problems with psychogenic explanations for physical illnesses (Paperback)

Angela Kennedy has assembled a major body of well-referenced research in "Authors of our own Misfortune? The Problems With Psychogenic Explanations for Physical Illnesses". The book is difficult in two ways. Kennedy writes as a social scientist and researcher. Her intended audience is primarily medical doctors, psychiatrists and psychologists who assign diagnoses of psychosomatic disorder to patients seen in their practices. Non-professional readers may find her long paragraphs and 8-line sentences to be hard slogging. In language and style, the book is nearly inaccessible to any but the most persistent of college educated non-physician readers.

This being said, a second and deeper sense of difficulty applies in this book. Kennedy directly challenges both medical doctors and mental health professionals to examine and revise their assumptions about a range of important issues pertaining to so-called "psychogenic" medical symptoms. These are by definition, symptoms of physical disorder or disease that are presumed to be "caused" by the mental state or thinking of the patient. The term "assumed" is highly central here. Kennedy is also challenging professional doctors who may be in emotional denial that what they practice in "psychosomatic" medicine is a dangerous and destructive mythology rather than a consistent or constructive healing art.

Kennedy effectively demolishes an entire branch of current psychiatric practice as codified in the 5th and previous editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. She demonstrates compellingly that there is no basis in science for such diagnoses as "Somatic Symptom Disorder", "Functional Neurological Symptom Disorder (Conversion Disorder)", "Hypochondriasis," or "Munchhausen Syndrome by Proxy". She also sets forth evidence that several presently controversial medical disorders are far better explained as poorly understood medical illness, than they are treated as outgrowths of any emotional or psychogenic process. These medical disorders include Fibromyalgia, Myalgic Encephalomyelitis /Chronic Fatigue Syndrome (ME/CFS), and Irritable Bowel Syndrome (IBS).

Kennedy demonstrates predictable and unnecessary harms that grow from misdiagnosing medical disorders as mental disease entities. Chief among these is the denial of effective medical assessment and treatment to millions of people who are instead written off as "head cases" and then disregarded as reliable reporters of their own medical symptoms and conditions. The careless or frustrated discharge of "difficult" patients who have subtle or unusual medical problems can and already has led to patient deaths. Likewise, among mental health professionals charged with caring for psychosomatic patients, there are no truly effective modalities of treatment. None.

If you are a mental health professional, then you should read this book and ask yourself how many of your patients have been harmed by the fallacies it reveals. If you are a patient who has been referred by a medical doctor for mental health evaluation, or who has been diagnosed with so-called psychogenic symptoms, then you should buy this book and give it to the practitioner who diagnosed you. You may even want to add a note on the flyleaf: "if you can't do better than this, then it's time you looked for an honest line of work!"

Fair Disclosure: I approached this book with a predisposition to accept its premises. I read it to verify that sufficient research was quoted to support those premises. As a social networking site moderator for over 5,000 chronic face pain patients, I have met many who were written off as head cases because their medical doctors didn't recognize what was causing their pain. I have separately published on the connections between psychogenic diagnoses and patient suicides. See "Psychogenic Pain and Iatrogenic Suicide" at DxSummit.org .

Thus I may have a bias of my own: having seen the damage done to medical patients with rare disorders by psychosomatic medicine, I am convinced that this branch of psychiatry is a complete crock! Practitioners of this mythology should be confronted with the harms they do, and if necessary barred from treating patients until they have been reeducated.

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Search Amazon for the author's name if you wish to purchase the book.

A proposal was submitted at the NCHS/CMS Coordination and Maintenance Committee meeting on September 18–19, 2013, to add Somatic symptom disorder (SSD) to the ICD-10-CM Tabular List and Index.

The proposal was for inserting SSD as an inclusion term to an existing ICD-10-CM code F45.1 Undifferentiated somatoform disorder.

At the March 19–20 meeting, the proposal to add Somatic symptom disorder to the Index was resubmitted.

There is still an opportunity to object to this proposal.

Objections should be sent by June 20 by email, to NCHS to nchsicd9CM@cdc.gov

I hope all stakeholders with concerns will oppose the incorporation of this controversial new disorder construct into ICD-10-CM.

If NCHS does approve the addition of Somatic symptom disorder to ICD-10-CM, it could leverage future replacement of the existing Somatoform disorders categories with this new, single diagnostic construct, to bring ICD-10-CM in line with DSM-5.

There are implications for ICD-11.

Once SSD is inserted into ICD-10-CM, the presence of this term within the U.S. modification of ICD-10 may make it easier for ICD-11 Revision Steering Group to justify approving proposals to replace the existing ICD-10 Somatoform disorders categories with a new, single disorder construct that would mirror SSD's defining characteristics – its positive psychological and behavioural features, its simplified criteria, its de-emphasis on "medically unexplained" – and facilitate harmonization between ICD-11 and DSM-5 disorder terms.

Christopher Chute, Mayo, chairs the ICD-11 Revision Steering Group. Dr Chute has suggested that following implementation, ICD-10-CM might be brought gradually in line with ICD-11 through a series of annual updates, for smoother transition to ICD-11-CM.

Inserting the SSD term into ICD-10-CM paves the way for disorder construct congruency between DSM-5, ICD-10-CM, ICD-11, and eventually, the ICD-11-CM modification.

I am in the middle of a custody and child support case and along the way applied for an was approved for SSI due to my chemical sensitivities. During my meeting with the court psychiatrist (required for both parents) as well as the SSI appointed psychologist, I stated that my symptoms onset after a severe chemical exposure. Why then did both diagnose me with SSD? Many many many chemically injured people can pinpoint either one significant exposure or a pattern of long term exposures (think work related exposure) that created the onset of their illness. Are the entire lot of us just suddenly, independently developing a mental illness? I highly doubt it. Don't most people suffering from a serious health challenge worry about it and spend time addressing it??